The two football practices unfolded roughly four years and 40 miles apart.

At each one, a teenage football player ran drills outside, the temperature hovering in the 80s. When each started showing signs of exertional heatstroke, training staff applied cooling packs to the player’s armpits and groins. But the trainers stopped short of best practices: taking the athlete’s rectal temperature and immersing him in cold water.

About two weeks later, both student-athletes were dead.

Jordan McNair, a 19-year-old offensive lineman at the University of Maryland, College Park, died of heatstroke in June.

Marquese Meadow, an 18-year-old defensive lineman at Morgan State University, died of heatstroke in August 2014.

A year before that, a third football player in the state suffered heatstroke during practice. After a long hospitalization, Towson University’s Gavin Class survived, which he attributes to the trainers’ quick action in treating him with cold-water immersion.

Experts question why other major heatstroke incidents in Maryland college football didn’t serve as a wake-up call before McNair’s death — and they wonder what could be different now.

After Minnesota Vikings offensive tackle Korey Stringer died of heatstroke following a 2001 training camp practice, the NFL took a hard look at its protocols. No professional football player has died of heatstroke since. Meanwhile, according to the research institute named for Stringer, more than a dozen college football players have died of heatstroke since 2000.

“Reactive change is a problem. We need people to be proactive,” said Robert Huggins, president of research and athlete performance and safety at the Korey Stringer Institute, a University of Connecticut-based nonprofit that studies sudden deaths in sports. “We’ve had enough heatstroke cases, enough deaths, enough near-deaths to learn from and to serve as examples.

“Heatstroke is 100 percent preventable. We scream that from the mountaintops.”

McNair’s story — which took place at Maryland’s flagship, a Power 5 conference school — has generated more sustained national interest than the previous two serious heatstroke incidents in Maryland. University President Wallace Loh also publicly said the school took “legal and moral responsibility for mistakes the training staff made” and brought in an outside consultant to review what happened that day.

McNair was attempting 10 repetitions of a 110-yard run during a May 29 practice when he started showing signs of exhaustion. Trainers eventually moved him to the football field house for treatment, about 30 minutes after the onset of symptoms. Another half-hour would pass before anyone called 911, records show. The trainers did not take his rectal temperature or use cold-water immersion treatment, which experts say are the two steps that could have saved his life. He died June 13.

After McNair’s death, media reports labeling the flagship’s football culture “toxic” brought more national scrutiny to campus, leading to a second investigation into allegations of bullying and abuse.

“I do feel the public eye is on the McNair case quite closely,” Huggins said. “I hope people really start to pay attention.”

The University System of Maryland’s governing body has been actively involved in overseeing the two investigations into the Terps’ football program. Board of Regents Chair James Brady spoke at a news conference last month, during which sports medicine consultant Dr. Rod Walters presented the findings from his review of the athletic department’s safety protocols.

Brady said the university system was “anxious” to learn from McNair’s death. He said Walters’ recommendations would be implemented not just in College Park, but at all other system institutions with football programs.

“We can and must learn from what happened," he said, “and make any appropriate and necessary changes to make sure it never happens again."

A University System of Maryland spokesman provided an emailed statement Wednesday, but it did not directly address questions about whether the heatstroke incidents involving Class and Meadow sounded alarms at universities across the state. Towson is part of the university system. Morgan State, though a Baltimore-based public institution, is not.

“The system has already shared the Walters report with every campus, asking them to review the recommendations and implement any necessary changes to their procedures and protocols,” the statement read.

A University of Maryland spokeswoman was not immediately available to comment for this article.

Towson athletic director Tim Leonard said Walters was also hired to review Towson’s protocols after Class’ hospitalization in 2013. While the Board of Regents was provided with those findings, Leonard said, the system never assumed control of the investigation, nor were there attempts to broaden the scope beyond his school.

Class said he was disappointed other state institutions didn’t double down on heatstroke prevention and treatment awareness after his harrowing medical saga. He collapsed during an Aug. 12, 2013, football practice, and his body temperature reached an estimated 111 degrees. He arrived at the hospital in a coma, with significant organ failure. He was later transferred to the Maryland Shock Trauma Center, where his heart stopped and doctors resuscitated him. After he was stabilized, he required a liver transplant.

“It didn’t shake anybody until Jordan,” said Class, now an assistant strength and conditioning coach at Johns Hopkins University. “You’d think after Marquese dying, too, that things would’ve been shaken up, but nope.”

The law firm representing McNair’s parents wrote a letter to Brady last month demanding to know what the university system had gleaned from what happened to Class and Meadow.

“The facts that need to be disclosed now involve the systemic failures throughout the University System that preceded Jordan’s death, despite having actual knowledge that an incident like this had occurred before,” lawyer Billy Murphy wrote.

Much of the Board of Regents has turned over since 2014.

Dr. David Chao, who served as the head team physician for the San Diego Chargers for 17 years, said college football programs should’ve learned their lessons after Stringer died — and even more so when a heatstroke incident hit closer to home.

“One death of a child or adult from heatstroke playing football is one too many,” he said.

Since McNair’s death, a number of changes have been made within the Maryland football program.

The Terps added more on-site cooling stations and boosted the amount of medical staff on hand during practices and games. Student-athletes use a new tool that helps them monitor hydration levels and they have expanded access to cold-water immersion therapy. Walters led in-service training for athletic department staff on implementing emergency plans.

Walters’ review found the flagship’s protocols on exertional heat illness meet standards, but proper steps were not followed in McNair’s case. The football team’s practice site was moved at the last minute, so the cold-water immersion tanks that are usually part of the field setup were not there on the day McNair fell ill. The university also didn’t monitor weather statistics in the recommended manner.

Walters said the failure of trainers to recognize McNair’s signs of heat illness was “a concern.”

Universities not only have to put the right protocols in place, Huggins said, but understand how to execute them properly.

In January 2012 — more than a year before Class was hospitalized — a group of leading athlete safety experts drafted a series of 10 recommendations for preventing sudden deaths in college sports.

They recommended conditioning periods be phased in gradually “to encourage proper exercise acclimatization and to minimize the risk of adverse effects on health.” McNair’s final workout was his first team activity in more than a month.

And they recommended that exercise and conditioning activities should not be used as punishment. Meadow fell ill while running during a “punishment practice,” according to a lawsuit filed by his mother.

The lawsuit, which ended in a settlement, states that Meadow attended a practice on Aug. 10, 2014, that was “scheduled to punish certain individuals on the team for team rule violations.” About an hour in, Meadow began stumbling and became disoriented — his temperature eventually reaching 106 degrees. At the hospital, he went into liver and kidney failure and suffered a brain injury because of the loss of oxygen. He remained in the intensive care unit on a ventilator for two weeks, before he died surrounded by family.

His mother, Benita Meadow, said when she saw McNair’s death reported in the news, it took her right back to the day her son fell ill.

“I couldn’t believe it was happening again,” she said in an interview. “The University of Maryland and Morgan State are like sister schools. It scared me and it made me angry — how is this still happening, so close and in the same way?

“This can’t be swept under the rug. … There has to be a change now.”

The Morgan State football team has since implemented new protocols, The Sun reported in August. Before practice, each athlete receives a 1-gallon jug of water. The players take two mandatory water breaks, without their helmets on. At the end of each workout, the players pile into ice tubs on the sidelines for a required 20-minute cool-down. Morgan State officials did not respond to requests for comment for this article.

After Class’ heatstroke, Towson also re-emphasized preventative measures, Leonard said. Mandatory breaks are written into the practice schedule. Coaches and trainers preach the importance of hydration. Officials are always monitoring for new evidence-based recommendations on avoiding heatstroke.

It remains to be seen what impact McNair’s death will have on other athletics department practices across the state.

But his grieving parents are hoping for change. They’ve launched a foundation in their son’s honor, aimed at promoting awareness of heat-related illnesses, improving player safety and reducing heatstroke incidents among student-athletes. They say they don’t want any other parents going through what they are.

“While Jordan is not with us to build his legacy, as a family we are doing it for him,” his father, Marty, wrote in an open letter on the foundation’s website. “This is his legacy.”

Benita Meadow befriended McNair’s parents after their twin tragedies. She never imagined a friendship could stem from her grief, but she said their connection gives her renewed strength to talk about her son, whom she remembers for his drive, his big personality and his desire to be a humanitarian.

For years, it was too hard to tell her story. Now that heatstroke has struck another Maryland college athlete, it’s different.